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Nguyen The Tich S.,Angers University Hospital Center | Cheliout-Heraut F.,Service de Physiologie Explorations Fonctionnelles
Neurophysiologie Clinique

Pediatric EEG in the intensive care unit (ICU) requires specific technical requirements in order to yield relevant data depending upon clinical scenario: diagnosis of electroclinical or subclinical seizures, their quantification before and after therapeutic changes and sometimes evaluation of severity of cortical dysfunction. The urgent nature of these indications implies the rapid set-up of the EEG system by qualified staff and possibility of maintaining the electrodes in place during long periods of time. Various techniques are available today for EEG monitoring, the interpretation of which depends on the contribution of an experienced physician. Among recent techniques, those most commonly used are trend curves obtained via signal analysis such as amplitude EEG (a-EEG) and density spectral array (DSA) or compressed spectral array (CSA). Trend curves enable the digital creation of a display graph containing several hours of transformed and compressed EEG recorded data. Visualized on one sole display graph, these trend curves can facilitate the identification of very slow changes in EEG background activity and their variation (alertness cycles, changes linked to treatment administrations) as well as seizure patterns and their quantification. In this chapter, we propose a brief overview of monitoring techniques, followed by a review of the various data yielded by EEG monitoring as well as the relevance of this type of management; finally, detailed clinical indications will be discussed after thorough analysis of the literature. © 2015 . Source

Hu H.,University of Paris Descartes | Hu H.,Nanchang University | Batteux F.,University of Paris Descartes | Chereau C.,University of Paris Descartes | And 7 more authors.
Journal of Pathology

Renal ischaemia-reperfusion injury (IRI) is consecutive to tissue oxidative damage and cell apoptosis that lead to acute renal failure (ARF) in renal allografts. The aim of this study was to investigate the beneficial effects of a pretreatment by clopidogrel on renal IRI in mice. IRI was induced by bilateral renal ischaemia for 45 min followed by reperfusion. Sixty-two healthy male BALB/c mice were randomly assigned to one of the following groups: PBS + ischaemia-reperfusion (IR); clopidogrel + IR; PBS + sham IR; clopidogrel + sham IR. Clopidogrel (25 mg/kg) or PBS was administered per os to the animals via a gastric cannula 24 h before operation. All mice were given a single dose of clopidogrel or PBS. Renal function histological damage, renal cell apoptosis, renal antioxidant activities, and CD41 expression were determined 24 h after reperfusion. The survival rates were evaluated over 7 days. Animals pretreated with clopidogrel had lower plasma levels of blood urea nitrogen (BUN) and creatinine, lower histopathological scores, and improved survival rates following IR. Renal cell apoptosis induced by IR was decreased in kidneys of mice pretreated by clopidogrel, with an increase in Bcl-2 and Bcl-xL expression and a decrease in caspase-3, caspase-8, and Bax expression. Renal reduced glutathione, superoxide dismutase, and catalase activities were unmodified by the pretreatment with clopidogrel. However, clopidogrel resulted in an increased total antioxidant capacity of the kidney. Furthermore, pretreatment by clopidogrel decreased the number of CD41-positive cells. Thus, clopidogrel exerts protective effects on renal IRI in mice by abrogating renal cell apoptosis as a consequence of improved renal antioxidant capacity and could be tried as a novel therapeutic tool in renal IRI. Copyright © 2011 Pathological Society of Great Britain and Ireland. Copyright © 2011 Pathological Society of Great Britain and Ireland. Source

Cossi M.-J.,University of Limoges | Gobron C.,Service de Physiologie Explorations Fonctionnelles | Preux P.-M.,University of Limoges | Chabriat H.,University Paris Diderot | Houinato D.,University of Limoges
Cerebrovascular Diseases

Background: Little is known about the burden of stroke in sub-Saharan Africa that may increase with the ongoing demographic and socioeconomic transition. This study aims to assess the prevalence of stroke, its related disability rate and consequences in the quality of daily life in an urban door- to-door survey in Cotonou, Benin. Methods: A three-phase door-to-door study was performed in two districts of Cotonou with a broad range of socioeconomic income. A population of 15,155 individuals aged ≥15 years was evaluated. The first phase consisted in screening of stroke in the population using the modified WHO questionnaire, the second phase included the medical evaluation of all suspected cases, and in the third phase the diagnosis of stroke was confirmed by CT scan evaluation. Results: Out of 15,155 subjects, 321 cases were identified as possible stroke cases. The diagnosis was confirmed in 70 cases. The crude prevalence of stroke was thus estimated to be 4.6/1,000 (8.7/1,000 and 7.7/1,000 adjusted to the WHO and SEGI World Population). The mean age of the patients at onset was 56 ± 13 years. Sixty percent of stroke survivors had a Rankin score ≥2, and CT scan was found abnormal in 90.0% of them. Conclusion: The stroke prevalence in urban areas of Cotonou is higher than that reported in other sub-Saharan countries, and the majority of stroke survivors present with good functional recovery and without severe disability in their everyday life. Copyright © 2012 S. Karger AG, Basel. Source

Ng Wing Tin S.,University Paris Est Creteil | Ciampi de Andrade D.,Service de Physiologie Explorations Fonctionnelles | Ciampi de Andrade D.,University of Sao Paulo | Goujon C.,University Paris Est Creteil | And 3 more authors.
Clinical Neurophysiology

Objective: To characterize sensory threshold alterations in peripheral neuropathies and the relationship between these alterations and the presence of pain. Methods: Seventy-four patients with length-dependent sensory axonal neuropathy were enrolled, including 38 patients with painful neuropathy (complaining of chronic, spontaneous neuropathic pain in the feet) and 36 patients with painless neuropathy. They were compared to 28 age-matched normal controls. A standardized quantitative sensory testing protocol was performed in all individuals to assess large and small fiber function at the foot. Large fibers were assessed by measuring mechanical (pressure and vibration) detection thresholds and small fibers by measuring pain and thermal detection thresholds. Results: Between patients with neuropathy and controls, significant differences were found for mechanical and thermal detection thresholds but not for pain thresholds. Patients with painful neuropathy and those with painless neuropathy did not differ regarding mechanical or thermal thresholds, but only by a higher incidence of thermal or dynamic mechanical allodynia in case of painful neuropathy. Pain intensity correlated with the alteration of thermal detection and mechanical pain thresholds. Conclusions: Quantitative sensory testing can support the diagnosis of sensory neuropathy when considering detection threshold measurement. Thermal threshold deterioration was not associated with the occurrence of pain but with its intensity. Significance: There is a complex relationship between the loss or functional deficit of large and especially small sensory nerve fibers and the development of pain in peripheral neuropathy. © 2013 International Federation of Clinical Neurophysiology. Source

Duong-Quy S.,Service de Physiologie Explorations Fonctionnelles
Revue des Maladies Respiratoires Actualites

Major advances have been made in recent years in the treatment of pulmonary hypertension with a wide range of available therapeutic option, including prostacyclins, endothelin receptor antagonists, and phosphodiesterase type-5 inhibitors. Results of clinical trials with these compounds have shown that improvements in haemodynamic parameters, exercise capacity as well as WHO functional class might be obtained. © 2011 Société de Pneumologie de Langue Française (SPLF). Source

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